Different Ways to Balance the Spine

Claus, Andrew; Hides, Julie; Moseley, G. Lorimer; Hodges, Paul W.

doi:10.1097/brs.0b013e3181908ead

Cited by 151 publications

(55 citation statements)

References 49 publications

(33 reference statements)

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“…13 Some individuals prefer to sit in a more kyphotic or lordotic lumbar posture compared to pain-free individuals, 13 and these postures are related to differences in the level of muscle activity as measured with electromyographic (EMG) signal. 12 Erector spinae (ES) EMG signal amplitude is reduced when healthy individuals adopt lumbar flexion/kyphosis postures 8,33 and in people with LBP who use this posture naturally. 32 In contrast, ES EMG is increased in extended/lordotic postures in healthy individuals 8,33 and in patients who prefer this posture.…”

Section: T T Resultsmentioning

confidence: 99%

“…12 Erector spinae (ES) EMG signal amplitude is reduced when healthy individuals adopt lumbar flexion/kyphosis postures 8,33 and in people with LBP who use this posture naturally. 32 In contrast, ES EMG is increased in extended/lordotic postures in healthy individuals 8,33 and in patients who prefer this posture. 3 Earlier studies 3,8,12,32,33 of muscle activation levels in sitting have referred to different patterns of ES EMG signal amplitude in different postures.…”

Section: T T Resultsmentioning

confidence: 99%

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Recruitment of Discrete Regions of the Psoas Major and Quadratus Lumborum Muscles Is Changed in Specific Sitting Postures in Individuals With Recurrent Low Back Pain

Park

Tsao²,

Claus³

et al. 2013

J Orthop Sports Phys Ther

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Sitting may contribute to development and main tenance of low back pain (LBP), 2,23 which may be related to changes in trunk muscle control. 12 Although the psoas major (PM) and quadratus lumborum (QL) contribute to control of spinal curvature in upright sitting, it is not known whether the activity of these muscles changes in individuals with recurrent LBP. Opposing interpretations of compromised 5,11,18 or augmented 15,38 muscular activity have been debated, but there are no directly recorded data of PM and QL activity in sitting, and no previous work, to our knowledge, has considered the complex anatomy 6,36 or the potential for changes in activation of discrete regions of the PM and QL.Sitting commonly exacerbates LBP, 29,39 and difficulty adopting neutral, T T STUDY DESIGN:Cross-sectional controlled laboratory study. T T OBJECTIVES:To investigate potential changes in the function of discrete regions of the psoas major (PM) and quadratus lumborum (QL) with changes in spinal curvatures and hip positions in sitting, in people with recurrent low back pain (LBP). T T BACKGROUND:Although the PM and QL contribute to control of spinal curvature in sitting, whether activity of these muscles is changed in individuals with LBP is unknown. T T METHODS: Ten volunteers with recurrent LBP(pain free at the time of testing) and 9 pain-free individuals in a comparison group participated. Participants with LBP were grouped into those with high and low erector spinae (ES) electromyographic (EMG) signal amplitude, recorded when sitting with a lumbar lordosis. Data were recorded as participants assumed 3 sitting postures. Fine-wire electrodes were inserted with ultrasound guidance into fascicles of the PM arising from the transverse process and vertebral body, and the anterior and posterior layers of the QL. T T RESULTS:When data from those with recurrent LBP were analyzed as 1 group, PM and QL EMG signal amplitudes did not differ between groups in any of the sitting postures. However, when subgrouped, those with low ES EMG had greater EMG signal amplitude of the PM vertebral body and QL posterior layer in flat posture and greater EMG signal amplitude of the QL posterior layer in short lordotic posture, compared to those in the pain-free group. For the group with high ES EMG, the PM transverse process and PM vertebral body EMG was less than that of the other LBP group in short lordotic posture. T T CONCLUSION:The findings suggest a redistribution of activity between muscles that have a potential extensor moment in individuals with LBP. The modification of EMG of discrete fascicles of the PM and QL was related to changes in ES EMG signal amplitude recorded in sitting.

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Section: T T Resultsmentioning

confidence: 99%

Section: T T Resultsmentioning

confidence: 99%

Recruitment of Discrete Regions of the Psoas Major and Quadratus Lumborum Muscles Is Changed in Specific Sitting Postures in Individuals With Recurrent Low Back Pain

Park

Tsao²,

Claus³

et al. 2013

J Orthop Sports Phys Ther

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“…Although patients with LBP likely to relate to altered coordination between muscles, specifically an inability to activate deep/short lumbar muscles (that extend the lumbar spine) separately from more superficial/multisegmental muscles (that extend larger spine segments, including lumbar and thoracolumbar regions). 2,5 Loss of differential control of these muscles has been identified. 19,29,31 Previous assessments of dissociation of lumbopelvic from thoracic motion have involved dichotomous outcomes as a part of a test battery.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Clinical Test of Thoracolumbar Dissociation in Chronic Low Back Pain

Cancino

Schabrun²,

Danneels³

et al. 2015

J Orthop Sports Phys Ther

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Motor control deficits are common in chronic/recurrent low back pain (LBP) 3,13,19,24,33,34,36 and include altered paraspinal muscle function. 4,5,19,29 Recovery from LBP does not ensure restoration of spine function or movement, and recurrent LBP involves persistent alterations of motor control, including modified coordination between short/deep (eg, multifidus) and long/ superficial (eg, thoracic erector spinae) paraspinal muscles, with a tendency to contract these muscles en masse rather than to activate T T BACKGROUND:Control deficits of back muscles and trunk movement are common in chronic/recurrent low back pain (LBP). A reliable clinical test to rate an individual's ability to dissociate lumbopelvic movement from the thoracolumbar region has been described. This test rates the performance quality of 5 key aspects against criterion standards. T T METHODS: Concurrent validity was examinedby comparison of clinical test scores (overall score and each individual criterion) against spine kinematics. Discriminant validity was evaluated by comparison of scores between pain-free controls and participants with LBP. A receiver operating characteristic curve was calculated to determine the optimal cutoff or score to differentiate between good and poor performers. T T RESULTS:Concurrent validity was supported by the significant correlation between the total score and motion of the T5 vertebra relative to the S1 vertebra (P<.05). Scores for some (4 correlations of 14 measures) but not all individual criteria were correlated with the kinematic features that each criterion was expected to reflect. Discriminant validity was supported by higher test scores for pain-free controls than for participants with LBP after 2 minutes of training (P = .045). Scores of less than 5.5 were more prevalent in the LBP group (pretraining LBP versus control, 72% versus 35%; P = .008; posttraining LBP versus control, 48% versus 16%; P = .018). T T CONCLUSION:This preliminary study of concurrent and discriminant validity of the test provides a foundation to further investigate its utility to characterize thoracolumbar movement patterns in individuals with LBP.

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“…Claus et al (2009) found that increasing anterior pelvic tilt up to the point of achieving a lordosis up to the thoracolumbar junction resulted in the highest measured activity of both TrA and LM compared to slumped and hyperlordotic (extended into the thoracic spine) postures. Therefore, the maintenance of a lumbar lordosis is a cornerstone of specific motor control training (O'Sullivan et al, 2006;Claus et al, 2009;Roussouly et al, 2005).…”

Section: Introductionmentioning

confidence: 90%

“…As the motion capture system used was unable to produce results with reference to a normal spinal posture or vertical reference, the analysis only automatically recruits LM and TrA , and that hyper-and hypo-lordotic postures reduce LM and TrA activity (Claus et al, 2009). This supports the suggestion that FRED exercise could be useful in the restoration of LM and TrA function.…”

Section: Limitations Of the Studymentioning

confidence: 99%

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

Winnard

Debuse

Wilkinson

et al. 2017

Musculoskeletal Science and Practice

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BackgroundDysfunction of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles is associated with low back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) has shown potential as a non-specific LBP intervention by automatically recruiting LM and TrA. Loss or lordosis and altered lumbopelvic positioning has also been linked to LBP and is often trained within LM and TrA interventions. The effect that FRED exercise has on lumbopelvic positioning and lumbar lordosis is unknown. ObjectivesTo assess the effect of FRED exercise on lumbopelvic kinematics and alignment to establish whether FRED exercise promotes a favourable lumbopelvic posture for training LM and TrA. DesignWithin and between-group comparison study MethodOne hundred and thirty participants, 74 experiencing LBP, had lumbopelvic kinematic data measured during over-ground walking and FRED exercise.Magnitude-based inferences were used to compare walking with FRED exercise within participants and between the asymptomatic and LBP groups, to establish the effects of FRED exercise on lumbopelvic kinematics, compared to walking, in each group. ResultsFRED exercise promotes an immediate change in anterior pelvic tilt by 8.7 degrees compared to walking in the no-LBP and LBP groups. Sagittal-plane spinal extension increased during FRED exercise at all spinal levels by 0.9 degrees in the no-LBP group, and by 1.2 degrees in the LBP group. ConclusionsFRED exercise promotes a lumbopelvic position more conducive to LM and TrA training than walking in both asymptomatic people and those with LBP. Highlights A posture conducive to LM and TrA training was promoted. The posture appears to occur automatically in people with and without LBP. Exercise on the FRED may be effective for LM and TrA training.

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Different Ways to Balance the Spine

Abstract: Discrete combinations of muscle activity supported the 3 different sagittal balanced postures in sitting, providing new detail for surgeons, researchers, and therapists to distinguish between different sagittal balanced postures.

Cited by 151 publications

References 49 publications

Recruitment of Discrete Regions of the Psoas Major and Quadratus Lumborum Muscles Is Changed in Specific Sitting Postures in Individuals With Recurrent Low Back Pain

Recruitment of Discrete Regions of the Psoas Major and Quadratus Lumborum Muscles Is Changed in Specific Sitting Postures in Individuals With Recurrent Low Back Pain

Validation of a Clinical Test of Thoracolumbar Dissociation in Chronic Low Back Pain

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

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